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Transit-time ultrasound technology-assisted lymphatic supermicrosurgery

Published:August 05, 2015DOI:https://doi.org/10.1016/j.bjps.2015.07.020
      Lymphatic supermicrosurgery, or lymphaticovenular anastomosis (LVA), is increasingly performed for the treatment of lymphedema due its efficacy and minimal invasiveness.
      • Yamamoto T.
      • Yamamoto N.
      • Numahata T.
      • et al.
      Navigation lymphatic supermicrosurgery for the treatment of cancer-related peripheral lymphedema.
      When performing the LVA, it is important to select healthy, functioning lymphatic vessels because the procedure relies on establishing a favorable lymph-to-vein pressure gradient.
      • Chang D.W.
      • Suami H.
      • Skoracki R.
      A prospective analysis of 100 consecutive lymphovenous bypass cases for treatment of extremity lymphedema.
      • Chen W.
      • Yamamoto T.
      • Fisher M.
      • Liao J.
      • Carr J.
      The “Octopus” lymphaticovenular anastomosis: evolving beyond the standard supermicrosurgical technique.
      To our knowledge, no method currently exists that allows direct intraoperative measurement of the lymphatic flow. Surgeons, therefore, rely on intraoperative visual inspection when selecting the lymphatic vessels. After completing an anastomosis, the anastomotic patency is commonly assessed by visually observing for blood “wash-out” in the vein. This observation is qualitative in nature and can lead to false positive/negative. Transit-time ultrasound technology (TTUT), with its sensitivity reaching 0.01 mL/min,

      Transonic MU-Series Microsurgical Volume Flow Probes Offer Unprecedented Resolution/Accuracy. Transonic Technical Note. Microvascular Section. http://www.transonic.com/tasks/render/file/?fileID=75B5D033-5056-9046-935794BDC50807B4.

      offers potential in measuring the minuscule flow in these microscopic vessels. In this letter, we describe our early experience of using TTUT in this novel application.
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